Case Management Workflow Lead

Inova Alexandria Hospital Case Management Team is looking for a dedicated Experienced Case Manager Workflow Lead to join the Case Management Team. This role will be Full-Time, Day Shift, Monday - Friday 8:30 am - 5:00 pm + weekend rotations.

Inova Alexandria Hospital is a community hospital dedicated to offering a full range of healthcare services for all ages. We are the oldest continuously operating community hospital in Virginia. For more than 150 years, we have provided high quality medical care close to home for the communities we serve, earning us recognition for many "firsts" in patient care.

Inova is consistently ranked a national healthcare leader in safety, quality and patient experience. We are also proud to be consistently recognized as a top employer in both the D.C. metro area and the nation.

Featured Benefits:

• Committed to Team Member Health: offering medical, dental and vision coverage, and a robust team member wellness program.
• Retirement: Inova matches the first 5% of eligible contributions - starting on your first day.
• Tuition and Student Loan Assistance: offering up to $5,250 per year in education assistance and up to $10,000 for student loans.
• Mental Health Support: offering all Inova team members, their spouses/partners, and their children 25 mental health coaching or therapy sessions, per person, per year, at no cost.
• Work/Life Balance: offering paid time off, paid parental leave, and flexible work schedules

Case Manager Flow Lead Job Responsibilities:

• Serves as a Lead and resource for Discharge Planners (DCP) and the multi-disciplinary team by supporting the Discharge Planners (DCP) with guidance, training, participating in Multi-Disciplinary Rounds (MDRs), and management of patient assignments.
• Participates in the assessment of patients' clinical and psychosocial needs through review of patient information, personal contact with patients/families and interdisciplinary care team members, assures referrals for Social Determinants of Health (SDOH) patient/family needs, and identifies at risk populations by using approved screening tools and following established reporting procedures.
• Initiates and facilitates referrals to specialists, clinics, home healthcare, hospice, SNF, acute rehab, LTAC, TCM, medical equipment and supplies as indicated.
• Communicates routinely with patients, families, interdisciplinary healthcare team members and other appropriate parties with regard to the status of patients' care plans, progress toward treatment goals, identification of concerns/problems, problem solving and assisting with conflict resolution when necessary. Addresses/resolves system problems impeding diagnostic or treatment progress, documents as necessary to ensure continuity of care.
• Seeks consultation from appropriate disciplines/departments as required to expedite care and facilitate discharge.
• Communicates with payers or required parties to ensure reimbursement certification for assigned patients and discusses payer criteria with the Discharge Planner and issues on a case by case basis with clinical staff and follows-up to resolve problems with payers as needed.
• Works closely with Discharge Planners (DCP), members of patients' healthcare teams to manage and coordinate all areas of care and collaborates with the DCP, interdisciplinary care teams, patients and families in the assessment and coordination of discharge planning needs; collaborating with internal and external case managers.
• Ensures safe care to patients by adhering to policies, procedures and standards, within budgetary specifications including time/supply management, productivity and accuracy of practice.
• Assists in the collection and reporting of resource and financial indicators including clinical metrics case mix, LOS, cost per case, excess days, resource utilization, readmission rates, denials and appeals.
• Collects, analyzes and addresses variances from plans of care and care paths with physicians and/or other members of the healthcare team, and collects delay and other data, as well as quality metrics, for specific performance and/or outcome indicators.

Minimum Requirements:

• Education: Requires a Bachelor's Degree in Nursing or Master's Degree in Social Work.
• Experience: Requires a minimum of four (4) years acute care case management experience in an acute healthcare environment. Demonstrated understanding of DCP for specific disease states. Understanding of Social Determinants of Health (SDOH) impact on health.
• License: Must be licensed in the Commonwealth of Virginia to practice as a Registered Nurse (RN) or licensed as a Social Worker in Virginia or eligible to practice on the Commonwealth of Virginia as a Social Worker.
• Certification: Basic Life Support (BLS) for Healthcare Provider certification from the American Heart Association required upon start.
  
  
  
  • Must have one of the following: Accredited Case Manager (ACM) or Certified Case Manager (CCM)
  
  

Preferred Qualifications:

• Four (4) + years of previous Inpatient (hospital) case management experience, case management discharge planning, and supervisory/lead experience is highly preferred. Previous experience working through medically complex cases is also highly preferred.